Under a draft regulation prepared by the Ministry of Social Affairs, the prescribing conditions for certain ADHD medications containing specific active ingredients and reimbursed at a rate of 75 percent will change for children and young people aged 6-19.

Currently, prescribing such ADHD medications requires consultation with a psychiatric treatment team that includes, for example, a clinical speech therapist and two psychiatrists with additional qualifications in treating children. Under the change, these ADHD medications may be prescribed by either a psychiatrist or a psychiatrist with additional qualifications in child and adolescent psychiatry.

The requirement to consult a treatment team will be abolished, said Getter Hark, head of the Health Insurance Fund's medicines reimbursement service.

"This concerns two active ingredients used to treat ADHD: methylphenidate (sold under the brand names Ritalin, Concerta and others) and atomoxetine (Atominiex). These are first-line medications for children and young people aged 6-19. The change was developed in close cooperation with the Estonian Psychiatric Association and the aim is to bring prescribing conditions more closely in line with those for adults so that there are not such significant differences between age groups, as well as to bring treatment practices into line with the clinical guidelines," Hark said.

The change will take effect October 1 this year.

The Estonian Psychiatric Association said the existing requirement to consult a treatment team has been an unnecessary waste of time and is not in keeping with the logic of modern clinical practice.

Association Vice President Anne Kleinberg said excessive regulation of clinical practice is in the interests of neither patients nor doctors, as diagnosing ADHD and making treatment decisions are routine parts of a psychiatrist's work.

"There is no need to add a requirement to consult a treatment team, especially considering that the team may include, for example, a speech therapist and a psychologist or a mental health nurse, for whom prescribing medication is neither part of their work nor their responsibility," she said.

According to Health Insurance Fund statistics, both the number of prescriptions issued for ADHD medications containing methylphenidate and atomoxetine and the number of children and young people aged 6-19 receiving them have increased in recent years.

In 2021, for example, nearly 4,200 prescriptions were issued to around 950 children aged 6-10. So far this year, nearly 9,600 prescriptions have been issued to around 2,430 people in the same age group.

Experts stressed that changing the prescribing conditions will not alter the thorough decision-making process involved in diagnosis and treatment.

"We have certain rules for diagnosis that we have to follow and those rules are not imposed on us through medication-prescribing rules. We follow clinical guidelines, which set out the diagnostic criteria. That is what doctors use to make a diagnosis. It would be very strange to regulate that through a document governing the prescribing of medication," Kleinberg said.

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